Rheumatoid arthritis (RA) is an autoimmune disease. For unknown reasons, one’s own immune system starts thinking that his/ her joints are foreign & attacks them. This results in inflammation of the joints. The routine treatment includes medications that modulate the immune system (DMARDs) or medications that block the cytokines (biologics).
We are in the age of organ transplant. Kidney transplant has become an established therapy for those with kidney failure. How about immunity transplant since RA is an immune dysfunction. This is precisely what led the scientists to try out stem cell therapy for RA.
Unlike kidney, the immune system is not a solid organ that can be removed; hence chemotherapy is used to ablate the marrow (organ where the immune cells are generated). This is followed by infusion of stem cells. The stem cells give rise to a whole new immune system that does not attack the joints.
Geoff McColl first reported a successful stem cell therapy in a man with resistant RA in the October 1999 issue of Annals of Internal Medicine. A 39-year-old man with RA who had failed standard RA therapy was treated with stem cells from his identical twin brother. The results were dramatic & the patient could swim, ride a bicycle & was free of RA symptoms even after 2 years of the therapy.
Richard K. Burt also reported about a successful stem cell therapy in a lady with resistant RA in the August 2004 issue of Arthritis & Rheumatism. A 52-year-old lady with treatment resistant RA was treated with stem cells from her sister. She remained in remission even after 1 year of stem cell therapy. Her rheumatoid factor disappeared & so did the rheumatoid nodules. The joint inflammation & the morning stiffness settled & the ESR normalized.
However, this is easier said than done. These stories sound fabulous. Studies were taken up to study this therapy further. A study from Netherlands included 14 RA patients. Of the 12 who completed the study, 8 patients improved significantly within one year of therapy. 4 patients failed to respond & those who had responded relapsed & required reinstitution of DMARDs within 2 years of therapy. Snowden J & colleagues analysed the registry data of 76 patients who received the therapy in different studies. In most patients, disease-modifying anti-rheumatic drugs had to be reinstituted within 6 months for persistent or recurrent disease activity.
Zhang-Huo li and a team of researchers from Peking university People’s Hospital have come with a new approach recently. They studied the umbilical cord mesenchymal stem cells. They found that these cells can suppress the inflammatory effects of RA related fibroblast-like synoviocytes and T cells in cultures. They also showed promising results in animal models of inflammatory arthritis.
All in all, stem cell therapy for RA is in a developing phase. We will have to wait for further studies with different medications/ designs for a definitive take on this approach.
High-Dose Chemotherapy and Syngeneic Hemopoietic Stem-Cell Transplantation for Severe, Seronegative Rheumatoid Arthritis Geoff McColl et al October 5, 1999 131(7) 507-509
Verburg RJ, Kruize AA, van den Hoogen FH, et al. High-dose chemotherapy and autologous hematopoietic stem cell transplantation in patients with rheumatoid arthritis: results of an open study to assess feasibility, safety, and efficacy. Arthritis Rheum. 2001;44:754-760.
Snowden J, Moore J, Passweg JR, et al. Autologous stem cell transplantation in rheumatoid arthritis. Blood. 2001;98:860a.
Therapeutic potential of human umbilical cord mesenchymal stem cells in the treatment of rheumatoid arthritis. Liu Y et al Arthritis Res Ther. 2010;12(6):R210